Provider Demographics
NPI:1790011260
Name:STEVENS, KATELYN (PA -C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3835
Mailing Address - Country:US
Mailing Address - Phone:866-904-7721
Mailing Address - Fax:
Practice Address - Street 1:1117 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3835
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-364363A00000X
WAPA.60717760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant